Pain is a complex universal phenomenon; however, the way it is experienced, perceived and conceptualised is shaped by wider social, cultural and political environments. It is a symptom that is present in a wide range of medical conditions and it can have a significant impact on a person's quality of life and overall functioning. There are many different factors that can contribute to pain. These factors can be intertwined in such a way that it can make it difficult to separate one from the other.
There is much evidence to suggest that gender is an important factor in the modulation of pain. Stereotypes are abundant in society, detailing specific expectations that are suggested by, for example, gender. Their effects on the stigmatised groups can be detrimental. Gender stereotypes determine how women's experiences of pain are addressed and treated. In 2001 Soloman reported that healthcare staff often underestimated a patient's pain and this is particularly so with regards to women's pain. Gender differences can have significant influence on patient presentations and how a nurse makes their response.
Zhang et al (2021) suggest that healthcare staff regularly underestimate a patient's pain, particularly a woman's pain, this they suggest is based on a number of biases and beliefs that have little to do with what the woman is presenting with and what she is saying and how she is expressing her pain.
The provision of care and support will frequently involve an accurate assessment of pain, often this is from nonverbal cues; however, those undertaking the assessment may fall foul of systematic biases that are based on gender, ethnicity and other contextual factors. Gender stereotypes are particularly significant when a person's pain is being assessed (Zhang et al, 2021).
The nurse's role in interpreting pain expression is complex and is altered by their personal qualities, by social context and by broader factors, such as gender, age and cultural norms. As a result of the false belief that women are oversensitive to pain and that they express or exaggerate it more easily, healthcare staff often discount women's verbal reports and the nonverbal behaviours in expressing pain.
Accurate estimation of a person's pain is an important skill in both clinical and everyday settings. Zhang et al (2021) determined that pain estimation and treatment recommendations were biased by perceived patient sex. Perceivers (lay perceivers) underestimated women's pain relative to the actual self-reported pain, while at the same time overestimating men's pain relative to self-report. Furthermore, perceivers indicated that female patients would benefit more than their male patient counterparts from psychotherapy as opposed to medication when making a choice between the two.
Gender biases in pain estimation may be a barrier to effective pain care. There is much to be done by nurses and other healthcare workers to abolish the inequalities in pain care. Understanding that gender stereotypes have the real potential to inform how the nurse's estimation of others' pain can help those who offer care and support to reflect on the social and personal bias that impact their practice and subsequent treatment.
The nurse-patient relationship, with its goal of restoring or maintaining health and wellbeing is the foundation of the provision of high-quality, person-centred care. Nurses and other health professionals may take some comfort in thinking that the interactions of patients are fully objective, but all our contacts and interactions are affected by our own biases or assumptions. It is the way we manage these influences that will determine how they affect the care that we offer.
There is much to be done by nurses and other health professionals to eradicate the inequalities in pain and to address pain bias. Appreciating and taking into account our own responses in patient care is essential if we are aiming to avoid any mis-judgments, mistakes and harm to patients. Equity requires nurses to treat people according to their needs, not treating everyone in the same way.